A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

Advance care planning readiness for Chinese older people:An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration.Readiness for advance care planning is a patient's preparedness to engage in advance care planning.This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people.The current knowledge from the published studies was identified and synthesized by an integrative review.The conceptual framework was developed based on the social-ecological model and the theory of planned behavior.The factors from the social environment/community,health care professionals,and individual/family layers were defined.These factors may influence an individual's medical decision-making,which in turn triggers individual behavioral mechanisms that arise from interactions between motivations,attitudes,and beliefs.Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning par ticipation in China.This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people,and to design intervention studies to test the effect of family function on the readiness for advance care planning.

基于MES的某型产线APS系统设计与开发

传统的基于人工的排产、调度和统计的生产模式,在计划编排、生产异常扰动调整及生产进度追踪等方面已无法满足当前实际生产需求。高级计划与排程(APS)系统能够针对有限的生产资源约束,为生产任务精确调配车间生产资源和生产时间,为复杂的生产和供应问题找出最优化的解决方法,确保生产资源的充分合理应用。针对某产线的实际业务需求和工艺流程特点,在制造执行(MES)系统基础上,设计了一种基于MES的APS系统。考虑了生产异常扰动、多工序连续生产、工序资源关联等因素,将生产计划细化至工序级,有效地解决了人工计划排程难度大、生产异常响应慢、排程结果不准确等问题,提高了生产效率。

DYNAMIC ADVANCED PLANNING AND SCHEDULING WITH FROZEN INTERVAL FOR NEW ORDERS

A dynamic advanced planning and scheduling （DAPS） problem is addressed where new orders arrive on a continuous basis. A periodic policy with frozen interval is adopted to increase stability on the shop floor. A genetic algorithm is developed to find a schedule at each rescheduling point for both original orders and new orders that both production idle time and penalties on tardiness and earliness of orders are minimized. The proposed methodology is tested on a small example to illustrate the effect of the frozen interval. The results indicate that the suggested approach can improve the schedule stability while retaining efficiency.

The perceptions and experiences of advanced cancer patients and their families in advance care planning:a systematic review and synthesis of qualitative studies

Background:The goal of this study was to conduct a meta-synthesis of advanced cancer patients’and their relatives’experiences with advanced care planning(ACP)and to provide evidence-based guidance for the development and implementation of ACP in advanced cancer patients.Methods:We searched databases including China Knowledge Network,Wanfang database,VIP database,China Biomedical Literature Database,PubMed,Web of Science,Embase,Cochrane Library,and Cinahl from inception to April 2022 to collect qualitative studies on advanced cancer patients and families'experience about ACP.We use Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to evaluate the quality of literature.After quality assessment,meta-synthesis was used to summarize and explain the results.Results:Eleven qualitative studies were included involving 29 results and ten categories.Three integrated themes were extracted:facilitators and barriers to the implementation of advanced medical care programs as perceived by patients and families with advanced cancer;attitudes of patients with advanced cancer and their families towards pre-existing medical care programs;suggestions from patients with advanced cancer and their families on the implementation elements of the pre-existing medical care program.Conclusion:ACP is a complex social process and influenced by many factors.It requires joint efforts of different stakeholders to achieve high-quality and successful ACP.

康莱特注射液联合AP化疗方案治疗晚期NSCLC的疗效

目的观察康莱特注射液联合AP化疗方案治疗晚期非小细胞肺癌(NSCLC)的疗效。方法选取2020年1月—2022年12月遵义市中医院收治的晚期NSCLC患者60例作为研究对象,以随机抽签法将患者分为AP化疗组30例和联合化疗组30例。AP化疗组患者采取AP化疗方案治疗,联合化疗组患者在AP化疗组基础上予康莱特注射液治疗,2组均以3周为1个化疗周期,持续治疗4个化疗周期。比较2组近期疗效,治疗前后免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、血清肿瘤标志物[糖类抗原125(CA125)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)]及不良反应。结果联合化疗组客观缓解率为70.00%,高于AP化疗组的43.33%(χ^(2)=4.344,P=0.037)。治疗4个化疗周期后,2组IgG及血清CA125、CEA、NSE水平及AP化疗组IgA、IgM水平均较治疗前降低,但联合化疗组IgG、IgA、IgM水平高于AP化疗组,血清CA125、CEA、NSE水平低于AP化疗组(P<0.05或P<0.01)。联合化疗组血小板减少、血红蛋白减少、恶心呕吐发生率低于AP化疗组(P<0.05)。结论晚期NSCLC患者采取康莱特注射液联合AP化疗方案治疗能够降低免疫耐受及血清肿瘤标志物表达,延缓病情进展,降低不良反应发生率,增强疗效。

基于AP聚类算法的充电站/光伏电站一体化规划方法

文章基于熵权法构建光伏出力特性指标权重,利用AP聚类算法生成典型场景。同时,计入电动汽车负荷时空分布特性及需求响应能力,建立了负荷联动时空响应模型。基于分时电价与光伏典型场景出力,优化电动汽车充电时序及空间布局,满足充电站距离约束、系统网络约束等前提下,提出了以充电站年总成本最小、用户满意度指标最优的充电站/光伏电站一体化规划方法。最后,通过算例仿真,基于对各个场景下经济性与满意度等指标的权衡考量,求得了充电站/光伏电站一体化规划方案。

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre- and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention in-creased the respondents’ awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents’ awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

Readiness for Advance Care Planning in Older Adults: A Literature Review

Introduction: In the context of end-of-life care, interest in advance care planning (ACP) has increased as an approach that allows a person to live in the manner of his or her choosing until the end. ACP is a process of discussion among the elderly persons, family members, and medical staff. However, preparations necessary for starting ACP are not clear. In this study, we aim to clarify the readiness of ACP focusing on the elderly who are the center of end-of-life care. Methods: We reviewed the literature on the subject in the CINAHL and PubMed databases. The keywords used were “advance care planning” and “readiness”. Results: Twelve articles were selected for the final analysis. ACP readiness was broadly divided into preparations on the part of the elderly themselves, family members, and medical professionals. Conclusion: The most frequently reported factor in readiness for ACP was elderly people informing their families and physicians of their intentions. In addition, the establishment of communicative relationships among elderly persons, their family members, and medical professionals was considered readiness for commencing ACP. It was suggested that enhancing these types of readiness would help reduce the barriers to ACP, thereby facilitating its practice.

Advance Planning in the Context of a Psychiatric Acute Care Hospital:Acceptance of a Trialogical Pilot Project

A joint crisis plan is a written consensus-orientated agreement between mental health service users and professionals.The instrument is used to regulate a potential future hospital treatment.At the Clinics of Upper Bavaria(kbo-Kliniken des Bezirks Oberbayern)representatives of the clinics,the organized relatives and those affected developed the pilot project“Joint Crisis Plan”in a trialogical process.The pilot project was evaluated between 2015 and 2017.The qualitative study looked at the experiences with the implementation of the instrument medical treatment agreement in different local settings.In doing so it considered the complex effects of“advance directives”on various levels such as the subjective importance and meaning as experienced by the patients,the effects on face-to-face interactions between patients and the medical staff,and the effects on institutional structures.And it considered the local influence—such as medical cultures or economic and institutional conditions—on the implementation process and the use of this instrument.The results showed that patients need numerous competences to complete a joint crisis plan.Likewise the instrument affects self-efficacy and self-images of the patients and the relation between the patients and the clinical staff in a positive way.But if the joint crisis plan is insufficiently implemented,the instrument generates rather a mortification of the self.

Status quo of implementation of advance care planning: a review

Optimum care for patients with a terminal illness is dependent on understanding their values,beliefs,and preferences on end-of-life issues and providing service that meets their preferences.As the only way to explore patients’living wills,advance care planning(ACP)is an important means to honor patient autonomy and respect their human rights and dignity.ACP has been recognized as a key indicator for quality palliative care and endorsed into national health systems by many high-income countries;however,it is little known in China's Mainland.China is now facing a growing aging and terminally ill population with many unmet needs for end-of-life care;therefore,it is imperative to implement ACP in China.In this review,we clarify the relevant concept and suitable population for ACP,describe the current situation of implementation in high-income countries,and provide better suggestions for the future development of ACP in the mainland of China.

Visual analysis of advance care planning related studies

Backgroud:To provide a reference for the further development of the field of the advance care planning(ACP),through the visual analysis of the related literature on the ACP.Methods:Taking the core collection database of Web of ScienceTM as data sources,the method of subject word retrieval is adopted.Literature metrology and CiteSpaceⅤinformation visualization software were used to analyze the literature on ACP published from inception to September 2019.Results:A total of 1,981 literature were included.The number of ACP studies increased,USA published the most literature in the world,followed by Australia,Britain,Canada and the Netherlands and so on.The most leading published journal was the Journal of Palliative Medicine,and the highest impact factor was Palliative Medicine(4.956).Sudore,Rebecca L and Hillary D Lum are the key researcher networks with the largest amount of articles published in ACP field.The research content mainly included the definition,implementation process and implementation effect of ACP.Research focused on palliative care,hospice care,decision-making,communication,patient preference and so on.Conclusion:The studies on ACP is on the rise,the research content is deepening,which suggests that we can learn from the research results of foreign countries in this field and continue to deepen the research in the field of ACP in China.

贝伐珠单抗联合AP化疗方案治疗晚期NSCLC的疗效及对肿瘤标志物的影响

目的观察贝伐珠单抗联合AP化疗方案治疗晚期非小细胞肺癌(NSCLC)的疗效。方法回顾性选取2019年6月—2022年6月铜陵市立医院收治的晚期NSCLC患者80例,依据化疗方案不同分为AP组和联合化疗组,各40例。AP组给予培美曲塞二钠和顺铂;联合化疗组在AP组基础上给予贝伐珠单抗注射液,2组均以3周为1个周期,共治疗2个化疗周期。比较2组近期疗效,化疗前与化疗2个周期后血清肿瘤标志物、T淋巴细胞亚群、视觉模拟评分法(VAS)评分、EORTC生命质量测定量表评分,中位生存时间、无进展生存时间及不良反应。结果联合化疗组客观缓解率为47.50%,高于AP组的25.00%(χ^(2)=4.381,P=0.036)。化疗2个周期后,2组血清癌胚抗原、糖类抗原125、细胞角蛋白19片段抗原21-1、神经元特异性烯醇化酶水平、CD8^(+)低于化疗前,CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于化疗前,且联合化疗组低/高于AP组(P<0.01);2组VAS评分低于化疗前,认知功能、社会功能、情绪功能评分高于化疗前,且联合化疗组低/高于AP组(P<0.01)。联合化疗组中位生存时间、无进展生存时间长于AP组(P<0.01)。AP组与联合化疗组不良反应发生率比较,差异无统计学意义(P>0.05)。结论贝伐珠单抗联合AP化疗方案治疗晚期NSCLC患者的临床效果显著,可有效抑制病情进展,减轻疼痛,提高患者生活质量,可延长患者生存时间,且并不会增加不良反应。

Beyond Defense: Proactive Approaches to Disaster Recovery and Threat Intelligence in Modern Enterprises

As cyber threats keep changing and business environments adapt, a comprehensive approach to disaster recovery involves more than just defensive measures. This research delves deep into the strategies required to respond to threats and anticipate and mitigate them proactively. Beginning with understanding the critical need for a layered defense and the intricacies of the attacker’s journey, the research offers insights into specialized defense techniques, emphasizing the importance of timely and strategic responses during incidents. Risk management is brought to the forefront, underscoring businesses’ need to adopt mature risk assessment practices and understand the potential risk impact areas. Additionally, the value of threat intelligence is explored, shedding light on the importance of active engagement within sharing communities and the vigilant observation of adversary motivations. “Beyond Defense: Proactive Approaches to Disaster Recovery and Threat Intelligence in Modern Enterprises” is a comprehensive guide for organizations aiming to fortify their cybersecurity posture, marrying best practices in proactive and reactive measures in the ever-challenging digital realm.

补肺消积汤联合AP化疗方案治疗晚期非小细胞肺癌患者的效果

目的:观察补肺消积汤联合AP化疗方案(培美曲塞+顺铂)治疗晚期非小细胞肺癌(NSCLC)患者的效果。方法:选取2020年9月至2023年9月该院收治的86例晚期NSCLC患者进行前瞻性研究,按照随机数字表法将其分为研究组与对照组各43例,对照组采用AP化疗方案治疗,研究组在对照组基础上联用补肺消积汤治疗。比较两组临床疗效,治疗前后肿瘤标志物[细胞角蛋白21-1片段(CYFRA21-1)、癌胚抗原(CEA)]水平、生命质量[肺癌患者生存质量测定量表(FACT-L)]评分,以及不良反应发生率。结果:研究组疾病控制率为95.35%(41/43),高于对照组的79.01%(34/43),差异有统计学意义(P<0.05);治疗后,两组CYFRA21-1、CEA水平均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05);两组FACT-L评分均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:补肺消积汤联合AP化疗方案用于晚期NSCLC患者可提高疾病控制率和生命质量,降低肿瘤标志物水平,安全性良好,效果优于单用AP化疗方案。

The effect of advance care planning in patients with dementia: a protocol of systematic review and meta-analysis

Aim:To comprehensively synthesize and compare the effect of advance care planning for dementia patients.Design:Systematic review and meta-analysis.Methods:Ten electronic databases will be searched:the Cochrane Library,PubMed,Medline,Embase,PsycINFO,CINAHL PLUS,Scopus,Web of Science,British Nursing Index,clinical Trials,and grey literature sources.Individually or cluster randomized controlled trials that evaluated advance care planning in people with dementia will be incorporated.The research screening flow diagrams will be detailed in the PRISMA flow chart.Data extraction will be carried out in Microsoft Excel 2019 independently by two researchers,any disagreements will be discussed with the third researcher and resolved.We will use the Cochrane Risk of Bias tool to assess the methodological quality.Review Manager 5.3 Software will be used for data synthesis.If sufficient data from studies are available,we will conduct a subgroup analysis of the main outcomes.Conclusion:The systematic review will combine existing trials which may contribute to more convincing conclusions,providing new ideas for medical workers to implement palliative therapy in dementia patients,and further promoting the application of advance care planning for dementia patients.

基于APQP的嵌入式处理机特性分析研究

由于嵌入式处理机通常结构复杂,驻留应用较多,若无法早期识别风险则会造成难以估计的损失。基于产品质量早期策划APQP的嵌入式处理机特性分析提出将产品初始关重件和关重特性在策划阶段即方案设计阶段被确定,对嵌入式处理机的关重件和关重特性进行风险分析,并根据风险分析在本阶段以及后续阶段的关键过程予以控制。贯穿于嵌入式处理机前期策划、设计与开发、过程设计与开发、产品与过程确认及生产使用与服务整个过程,加强对嵌入式处理机生产、检验及研制过程的质量控制,进而提高产品质量并减少后期维护成本。

基于APS与MES集成的车间生产计划和调度方法研究

介绍了APS和MES的基本概念,并在分析现行车间生产计划和调度方法的基础上,提出了基于APS和MES集成的车间生产计划和调度方法,同时研究了与APS和MES集成相关的系统架构和关键实现技术。

高级排程计划APS发展综述

高级排程计划(APS)是二十世纪信息技术与现代管理思想相结合的产物。本文回顾了APS从萌芽到与ERP/SCM结合的过程,总结了APS的主要特点,并对我国企业应用APS的前景进行了分析与展望。